Polygraphic study in man to differentiate sleep-inducing action of hypnotics

Past, present, and future of sleep medicine research in Latin America

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Sleep medicine is a relatively young field with exponential growth in development and research in the last decades. Parallel to the advances in the United States, Latin America also had its beginnings in sleep medicine housed in neuroscience laboratories. Since the very first Latin American meeting in 1985, and the first sleep society in 1993, sleep research has undergone significant development in subsequent years. From contributions in animal research that allowed understanding of the activity of the brain during sleep to the studies that improved our knowledge of sleep disorders in humans, Latin America has become a scientific hub for expansion of sleep research. In this article, we present a historical account of the development of sleep medicine in Latin America, the current state of education and the achievements in research throughout history, and the latest advances in the trending areas of sleep science and medicine. These findings were presented during World Sleep Society meeting in Vancouver in 2019 and complement the work on sleep societies and training published by Vizcarra-Escobar et al in their article "Sleep societies and sleep training programs in Latin America" (J Clin Sleep Med. 2020;16(6):983-988).

Normal human subjects with slow reaction times and larger time estimations after waking have diminished delta sleep

A sample of 42 healthy young male human subjects was submitted to whole night polysomnography and attention performance tests upon awakening (simple visuomotor reaction time, RT, and time estimation, TE). In order to test whether performance is related to specific sleep parameters, the 15 fastest subjects (mean = 210 msec) and 15 slowest subjects (mean = 357 msec) in RT were compared in their TE and sleep parameters. Fast subjects were more precise in the estimation of 10 sec intervals (9.89; S.E. = 0.23 sec) than slow subjects (10.73; S.E. = 0.32). Slow subjects had significantly less delta sleep (mean = 73 min) than fast subjects (100 min, P less than 0.01) and otherwise similar sleep parameters. It can be suggested that attention after awakening is related to the amount of delta sleep in the night.

Effects of 1 week administration of two benzodiazepines on the sleep and early daytime performance of normal subjects

This study analyzed the effects of 1 week administration of alprazolam (AL; 0.25 mg), lorazepam (LO; 1 mg) and placebo (PL) on sleep as well as their residual effects on attention upon awakening. Under a crossed, double-blind design, six healthy male volunteer subjects between 19 and 30 years of age were studied. After two habituation sessions and a control session, each substance was given orally, twice a day for 7 days, with a 1-week washout period between administrations. At the end of each administration period, sleep studies were conducted from 2300 to 0700 hours. Evaluation of attention was carried out by means of a simple visuomotor reaction time (RT) task, and a time estimation (TE) task, that started at 0700 hours, lasting 1 h. Neither drug significantly affected any sleep variable. Both benzodiazepines tended to increase RT, but only LO did so significantly at the beginning of the attention test. No significant changes in predictive and failure responses during the RT task were produced by either drug. Also, no significant changes were observed in the TE. Even though only LO produced a significant increase of RT at the selected doses and with 1 week administration, it is suggested that both benzodiazepines could have residual effects on attention.

Psychopharmacologic analysis of an alleged oneirogenic plant: Calea zacatechichi

Calea zacatechichi is a plant used by the Chontal Indians of Mexico to obtain divinatory messages during dreaming. At human doses, organic extracts of the plant produce the EEG and behavioral signs of somnolence and induce light sleep in cats. Large doses elicit salivation, ataxia, retching and occasional vomiting. The effects of the plant upon cingulum discharge frequency were significantly different from hallucinogenic-dissociative drugs (ketamine, quipazine, phencyclidine and SKF-10047). In human healthy volunteers, low doses of the extracts administered in a double-blind design against placebo increased reaction time and time-lapse estimation. A controlled nap sleep study in the same volunteers showed that Calea extracts increased the superficial stages of sleep and the number of spontaneous awakenings. The subjective reports of dreams were significantly higher than both placebo and diazepam, indicating an increase in hypnagogic imagery occurring during superficial sleep stages.

Interhemispheric changes in alpha rhythm related to time perception

Each cerebral hemisphere processes environmental information in a different but complementary manner. Structures located in the left hemisphere are assumed to participate in symbolic-logic thinking. Time perception may be considered among such thinking processes. The present study evaluates bilateral occipito-central EEG activity in healthy, right-handed subjects which was produced while they performed a visuomotor monitoring task. The task consisted of two stages. The first stage involved the subject's learning a fixed time interval (10 sec) and the measurement of their reaction time. Subjects responded to an isolated light stimulus by pressing a button with the dominant hand. In the second stage, the subjects accuracy in estimating interval-length was evaluated. Two forms of EEG analysis were used, frequency and alpha ratio, each of which was measured both prior to and subsequent to the motor response. A reversal group was used to carry out a complementary test. Subjects responded in the first block of experiments with the non-dominant (left) hand and with the dominant hand in the second. Results showed that left hemisphere activity was continuous during the interval-learning stage and with optimal reaction times and remained continuous when estimation values approximated the real interval. In addition, in optimal reaction time and near to optimal time estimation responses, the left side showed lower frequency and alpha ratio than did the right. Finally a progressive enhancement in both parameters from the right hemisphere was related to deterioration in test performance. Results from the reversal group did not differ from those of the first group. As evaluated by gross measurements of the EEG, a predominant participation of the left hemisphere in time processing is concluded.

Pharmacokinetics and relative bioavailability of heptabarbital and heptabarbital sodium after oral administration to man

A method has been developed for the quantitative determination of heptabarbital [5-(1-cyclohepten-1-yl)-5-ethylbarbituric acid] in human plasma after administration of single therapeutic doses of the drug. It involves a single extraction step followed by gas chromatography with alkali flame ionization detection, and the results were linear in the concentration range 0.125 - 5.0 mug/ml plasma. The pharmacokinetics and relative bioavailability of heptabarbital and heptabarbital sodium were studied in a crossover design in 7 healthy volunteers after oral administration of 20 tablets containing 200 mg heptabarbital and hard gelatine capsules containing an equivalent amount of its sodium salt. Heptabarbital concentrations in plasma were determined at regular intervals. The absorption of heptabarbital from the tablets absorbed more rapidly and peak concentrations occurred between 1/3 and 2 h. In all cases the elimination of heptabarbital could be described by a single first-order process with an average half-life of 7.6 h (range 6.1 - 11.2 h). The half-life of the drug in each individual was about the same in the two trials. The relative bioavailability in each volunteer was estimated by comparing the areas under the plasma concentration curves. The sodium salt had an average bioavailability of 83% relative to the free acid. In some volunteers urinary excretion of unchanged heptabarbital was measured; cumulative excretion amounted to 0.16 - 0.30% of the administered dose. Four volunteers received one tablet each night for eight or ten days, but no accumulation was found. In three volunteers the half-life of the drug prior to and after these experiments did not change, whereas in the other volunteer the half-life decreased from 7.1 to 4.6 h. The possibility of enzyme induction should be considered when heptabarbital is taken regularly. It was concluded that heptabarbital was a suitable drug for the treatment of insomnia, since its half-life was rather short. Heptabarbital sodium may be used for induction of sleep, whereas Medomin tablets, i.e. heptabarbital free acid, may be prescribed when the maintenance of sleep is the primary reason for treatment with a hypnotic drug.